We have a 1 year contract opportunity for a Case Manager in Pleasanton, CA. This position will work from home after initial training onsite. Job Requirements: 3 year of customer service background required. This is not a call center or data entry. Will need to write summaries, conduct investigations, and write 20-30 letters a week to members. Excellent grammar and writing experience is required. Must be able to both communicate and handle[ "\t. Participate in managing the organization's compla... more details
job summary: We have a 1 year contract opportunity for a Case Manager in Pleasanton, CA. This position will work from home after initial training onsite. Job Requirements: 3 year of customer service background required. This is not a call center or data entry. Will need to write summaries, conduct investigations, and write 20-30 letters a week to members. Excellent grammar and writing experience is required. Must be able to both communicate and handle
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Participate in managing the organization's complaint and grievance process.\t
Accountable for investigation of all issues, including collection and documentation of appropriate data.\t
Identify and address specialty / flagged cases and follow appropriate processes for different types of cases\t
Communicate with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation and enhancement of the member experience.\t
Partner with and outreach to internal staff, other MS Departments, managers and physicians to resolve issues as quickly as possible.\t
Research, resolve and communicate complaints and grievances filed by members and communicate Health Plan's decisions appropriately back to member or their authorized representatives\t
Ensure that complaints and grievances are processed in accordance with regulations, compliance standards and policies and procedures.\t
Meet timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues.\t
Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and effectively manage case resolution inbox everyday\t
Participate in departmental meetings, trainings and audits as requested.\t
Answer questions and manage members on existing / open cases\t
Escalate issues to management as appropriate to maintain compliance.
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